Real-World Data Highlight Trends in Erenumab Prescribing, Patient Characteristics

Results of a retrospective analysis of erenumab use among migraineurs in the United States showed that although early use of the drug post approval focused on patients with more severe disease, over time, uptake expanded to a broader population of migraineurs. Findings, published in Advances in Therapy, indicate increased prescribing of erenumab by general practitioners and those outside of headache centers throughout the study window.

Erenumab, a monoclonal antibody, is administered monthly via self-injection of a 70- or 140-mg dose. The treatment blocks the calcitonin gene-related peptide (CGRP) receptor, which is believed to play a crucial role in migraine.

Despite being approved by the FDA in 2018, real-world evidence of erenumab’s use and characteristics of patients using the drug have not been fully investigated, researchers wrote. To characterize migraineurs initiating erenumab and analyze trends among subgroups, investigators assessed data of patients who began therapy between May 1, 2018 and September 30, 2019.

Deidentified clinical record data were gleaned from the Optum Electronic Health Record dataset, which included information on patient demographics and characteristics. All patients included were “at least 18 years of age, had at least 1 erenumab written prescription or administration during the patient identification period, at least 12 months of pre-index clinical activity and were included in an integrated delivery network,” authors wrote. Those who received anti-CGRP therapy in the year prior to the index date were excluded.

Of the 14,774 patients who met inclusion criteria, mean (SD) age was 46.3 (13.1) years, and the majority were White (88.7%) and women (86.4%). Neurologists/headache specialists most commonly initiated patients’ erenumab treatment (46.5%), followed by other health care professionals and general partitioners.

Most patients (59.8%) included were commercially insured; “during the 12-month pre-index period, commonly observed selected comorbid conditions included anxiety (30.6%), depression (28.2%), and cardiovascular diseases (26.4%), and the mean (SD) Elixhauser comorbidity score was 1.7 (5.5).”

Analyses revealed that throughout the study window:

• Mean (SD) Elixhauser comorbidity score decreased from 2.4 (5.9) to 1.7 (5.8).
• Prescription of erenumab by a neurologist/headache specialist remained relatively constant (slight numerical decrease from 52.4% to 45.1%).
• A nearly 2-fold increase was observed in the proportion of general practitioners prescribing erenumab as preventive treatment: 7.6% (May-July 2018) vs 13.9% (July-September 2019).

The proportion of patients with chronic migraine without aura (CMWA) was reduced by nearly half, among those patients with CMWA in the 3-month preindex period (from 38.2% to 17.3%) and those with CMWA in the 12-month preindex period (from 60.2% to 30.8%).

• Use of triptans, opioids and nonsteroidal anti-inflammatory drugs for migraine decreased monthly as erenumab initiation began.
• In subgroups of patients who initiated erenumab at different time periods, there was a nearly 2-fold increase in the proportion of patients who did not receive any preventive migraine treatment on the same date as a migraine diagnosis in the 12 months before erenumab initiation, from 26.3% to 46.5%.

Overall, results show “erenumab was prescribed to patients with more severe disease, as reflected by a higher comorbidity burden, more chronic migraines, and a greater use of preventive/acute medications compared with patients treated in subsequent time periods.”

As the current study is the first real-world study of its type to be published, researchers hypothesized physicians may have prescribed erenumab only to patients with more severe disease immediately following the launch of erenumab, based on published clinical data. As time went by, authors assume more knowledge was gained and physicians became more confident in prescribing the treatment to patients with less severe disease.

Generalization of results to the global population is not possible, marking a limitation to the study, and data recorded may have been inaccurate or subject to error. The study also did not analyze patient adherence to erenumab, which may provide more information on the treatment’s effectiveness.

Reference

Fang J, Korrer S, Johnson JC, et al. Real-world trends in characteristics of patients with migraine newly initiated on erenumab in the USA: a retrospective analysis. Adv Ther. Published online March 24, 2021. doi:10.1007/s12325-021-01677-y